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Multimodal Treatment of Occipital Tentorial Dural Arteriovenous Fistula Cognard III.
World Neurosurg. 2019 06; 126:171.WN

Abstract

Dural arteriovenous fistulas (dAVFs) are rare vascular malformations of uncertain pathophysiology. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 69-year-old patient who presented with spontaneous right-sided symptomatic chronic subdural hematoma, which was evacuated via burr hole. Due to lack of history of prior trauma, computer tomography angiography was performed, which showed dilated convoluted vessels in the right occipital region and an enlarged right posterior cerebral artery, suspected to be an arteriovenous malformation or dAVF. Subsequent angiography demonstrated occipital tentorial dAVF with primary cortical venous reflux (Cognard III) and reflux into the transverse sinus, fed primarily from the petrosquamous branch of the middle meningeal artery and neuromeningeal trunk. The fistula was initially treated by transarterial endovascular embolization of the occipital artery and neuromeningeal trunk with Onyx, achieving complete obliteration. However, follow-up angiography demonstrated recurrence of the lesion fed from the contralateral middle meningeal artery and pial branches of the enlarged right posterior cerebral artery. Given the recruitment of the contralateral supply from the left middle meningeal artery and ipsilateral posterior cerebral artery, we felt that surgical disconnection of the fistula was the best option for the patient. An occipital craniotomy with disconnection of the fistula without isolation of the transverse sinus was performed (Video 1), as published literature demonstrated lower intraoperative risk with disconnection only. The perioperative course was uneventful. Immediate postoperative and follow-up angiography demonstrated complete occlusion of the fistula.

Authors+Show Affiliations

Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA. Electronic address: Ivo.peto@icloud.com.Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA.Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

30862601

Citation

Peto, Ivo, et al. "Multimodal Treatment of Occipital Tentorial Dural Arteriovenous Fistula Cognard III." World Neurosurgery, vol. 126, 2019, p. 171.
Peto I, Abou-Al-Shaar H, Dehdashti AR. Multimodal Treatment of Occipital Tentorial Dural Arteriovenous Fistula Cognard III. World Neurosurg. 2019;126:171.
Peto, I., Abou-Al-Shaar, H., & Dehdashti, A. R. (2019). Multimodal Treatment of Occipital Tentorial Dural Arteriovenous Fistula Cognard III. World Neurosurgery, 126, 171. https://doi.org/10.1016/j.wneu.2019.02.185
Peto I, Abou-Al-Shaar H, Dehdashti AR. Multimodal Treatment of Occipital Tentorial Dural Arteriovenous Fistula Cognard III. World Neurosurg. 2019;126:171. PubMed PMID: 30862601.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multimodal Treatment of Occipital Tentorial Dural Arteriovenous Fistula Cognard III. AU - Peto,Ivo, AU - Abou-Al-Shaar,Hussam, AU - Dehdashti,Amir R, Y1 - 2019/03/09/ PY - 2019/01/14/received PY - 2019/02/21/revised PY - 2019/02/22/accepted PY - 2019/3/14/pubmed PY - 2020/1/14/medline PY - 2019/3/14/entrez KW - Arteriovenous malformation KW - Cortical venous reflux KW - Dural arteriovenous fistula KW - Surgical disconnection SP - 171 EP - 171 JF - World neurosurgery JO - World Neurosurg VL - 126 N2 - Dural arteriovenous fistulas (dAVFs) are rare vascular malformations of uncertain pathophysiology. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 69-year-old patient who presented with spontaneous right-sided symptomatic chronic subdural hematoma, which was evacuated via burr hole. Due to lack of history of prior trauma, computer tomography angiography was performed, which showed dilated convoluted vessels in the right occipital region and an enlarged right posterior cerebral artery, suspected to be an arteriovenous malformation or dAVF. Subsequent angiography demonstrated occipital tentorial dAVF with primary cortical venous reflux (Cognard III) and reflux into the transverse sinus, fed primarily from the petrosquamous branch of the middle meningeal artery and neuromeningeal trunk. The fistula was initially treated by transarterial endovascular embolization of the occipital artery and neuromeningeal trunk with Onyx, achieving complete obliteration. However, follow-up angiography demonstrated recurrence of the lesion fed from the contralateral middle meningeal artery and pial branches of the enlarged right posterior cerebral artery. Given the recruitment of the contralateral supply from the left middle meningeal artery and ipsilateral posterior cerebral artery, we felt that surgical disconnection of the fistula was the best option for the patient. An occipital craniotomy with disconnection of the fistula without isolation of the transverse sinus was performed (Video 1), as published literature demonstrated lower intraoperative risk with disconnection only. The perioperative course was uneventful. Immediate postoperative and follow-up angiography demonstrated complete occlusion of the fistula. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30862601/Multimodal_Treatment_of_Occipital_Tentorial_Dural_Arteriovenous_Fistula_Cognard_III_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)30608-4 DB - PRIME DP - Unbound Medicine ER -